Peripheral & Cranial Nerves

Front 1

CRANIAL NERVE disorders are commonly classified as?

Back 1

PERIPHERAL Neuropathies

Front 2

How many pairs of cranial nerves are there?

Back 2

12

Front 3

The 12 pairs of cranial nerves are considered the peripheral nerves of the?

Back 3

Brain

Front 4

Disorders usually involve the _____ or _____ or BOTH branches of a single nerve=

Back 4

Motor, Sensory; Mono neuropathies

Front 5

List some causes of cranial nerve problems?

Back 5

Tumors, trauma, infections, inflammatory processes, and idiopathic causes (unknown causes)

(2 T's & 3 I's)

Front 6

List 2 popular cranial nerve disorders and another problem we will talk about?

Back 6

Trigeminal Neuralgia, Bell's Palsy, and Herpes Zoster

Front 7

What's another name for Trigeminal Neuralgia?

Back 7

Tic douloureux

Front 8

What's another term for Bells Palsy?

Back 8

Acute Peripheral Facial Paralysis

Front 9

Approximately how many Americans each year are diagnosed? More common in women or men?

Back 9

15,000, more common in women

Front 10

At what age do a majority (90%) cases of this occur?

Back 10

After age 40

Front 11

The specific pathophysiology/cause is unknown, but there is a common theory. What cranial nerve is the trigeminal nerve?

Back 11

5 (Think of = > you can make a face with it.)

Front 12

What is one theory of what is responsible for the pain?

Back 12

Compression of blood vessels causes CHRONIC (long lasting/recurring) irritation of the Trigeminal Nerve (V) nerve root

Front 13

Irritation leads to increasing firing of the afferent (inside)/sensory nerve ____

Back 13

Fibers

Front 14

The Trigeminal nerve has _____ and _____ branches, however the ______ is mostly at play here.

Back 14

Sensory, Motor, Sensory

(So Motor, they can do everything fine- Open and close eyes, move everything- just sensory and pain at play)

Front 15

Which branches are primarily affected? & how many main branches are there?

Back 15

Mandibular (Jaw), and Maxillary area (cheeks), Opthalamic (Related to eyes) 3

Front 16

Risk factors for T.N? What is the main culprit?

Back 16

VIRUSES

Multiple Sclerosis,(MS) Hypertension, Herpes Virus infection (Cold sore/Zoster), infection of the teeth and jaw, and brainstem infarct.

Front 17

Define Infarct

Back 17

A small localized area of dead tissue resulting from failure of blood supply

Front 18

Symptoms of Trigeminal Neuralgia/Clinical Manifestations

Back 18

ABRUPT ONSET of paroxysms (violent attacks) of EXCRUCIATING pain (burning, knife-like, lightening-like) of forehead, sides of nose, cheeks, upper and lower gums, lips. Eyes start to have pain and twitching, tearing, excessive blinking

-These symptoms usually occur during the acute attack

Front 19

How longs do attacks approximately last?

Back 19

Seconds to minutes

Front 20

Symptoms are generally?

Back 20

Unilateral

Front 21

What usually triggers the symptoms?

Back 21

Light touch along nerve branches, chewing, teeth brushing, yawning, talking

(pain and temp changes less common)

Front 22

As a result the patient may?

Back 22

Avoid taking part in regular practices like eating (eating less), decrease their oral hygiene, isolate themselves from others, and increase sleep as a way to cope.

Front 23

Diagnostic Studies- Done to ______ out other diagnosis, with similar symptoms.

Back 23

Rule out

Front 24

Examples of certain tests that are done to rule out other diagnoses?

Back 24

CT scan, MRI, LP (lumbar puncture/spinal tap)

Front 25

Why is a CT scan done- to rule out ____?

Back 25

To rule out any lesions, tumors, or vascular abnormalities

Front 26

Why is an MRI scan done.LP- to rule out ____

Back 26

To rule out MS

Front 27

Define MS

Back 27

a chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord, whose symptoms may include numbness, impairment of speech and of muscular coordination, blurred vision, and severe fatigue.

Front 28

What else is typically done for standard purposes?

Back 28

Neurologic assessments (w/ audio logic evaluation), although results are usually normal

Front 29

Treatment of Trigeminal Neuralgia. Main goal=

Back 29

Relief of pain, either medically or surgically

Front 30

Medications don't provide _____ pain relief

Back 30

Permanent

Front 31

General classification of medications that tx this condition? Specific examples (4): How do they work?

Back 31

Anti-seizure medications, Carbamazepine (Tegretol), Trileptal, Neurontin (taken regularly)- Can help prevent acute attacks or promote remissions by lengthening the time needed for neuron repolarization , resulting in decreased neural firing

Front 32

Alternative therapies, due to medications not working as well?

Back 32

Acupuncture & Nerve blocking, with local anesthetics, Biofeedback (Again, relief of pain temporary)

Front 33

If other approaches are ineffective (drug therapy), what kind of treatment may be done?

Back 33

Surgical Treatment (Cut some of the nerves)

Front 34

Example of nursing Diagnoses affiliated with Trigeminal Neuralgia

Back 34

Acute pain, anxiety, impaired oral mucosa membrane, (think of teeth brushing) isolation

Front 35

Patients with Trigeminal Neuralgia are typically treated on an _____ basis

Back 35

Outpatient (Pts. won't be admitted for T.N., although they will most likely be treated for pain by ED, primary care, neurologist, etc.)

Front 36

Factors to consider when treating the patient (Interventions)

Back 36

Monitor pain relief, assessment of attacks (triggering factors, characteristics, frequency, and main management techniques) Look into patients nutritional status, hygiene (especially oral), monitor behavior (withdrawal), emotions (suicide, drug history, & lifestyle)

Monitor environmental temperatures (drafts)

Teach and assist with oral hygiene, when analgesia at peak (inability to feel pain)- small, soft, bristle toothbrush, warm mouth wash.

We need to avoid touching the face/itches

Food should be high in protein, easy to chew, with increased calories (served lukewarm)- CHEW ON UNAFFECTED SIDE.

Education regarding surgical procedures, diagnostic tests, medications

Try to decrease talking

Front 37

You need to monitor the patients response to _____ and note any side effects. What types of medications should be used with caution, as they can be addicting?

Back 37

Drug Therapy; strong opioids (morphine)

Front 38

If there is impairment of the corneal reflex, special attention needs to be paid to eye protection. Use of?

Back 38

Artificial tears ( eye drops/gtts) & eye shields.

Front 39

Bells Palsy AKA

Back 39

Peripheral Facial Paralysis (Acute)

Front 40

A disorder characterized by the inflammation of cranial nerve? One side of the face? Primary culprit?

Back 40

7, on one side of the face, in the absence of any other disease (ex: stroke) Again, goes back to viruses

Front 41

Each year approximately how many people will get diagnosed?

Back 41

20 per 100,000

Front 42

Bells Palsy can affect ___ age group. However, more commonly seen from?

Back 42

ANY; 20-60 yoa

Front 43

What is the percentage of patients that have full recovery in ___ months, if treatment started immediately?

Back 43

6; 85%

Front 44

15% have residual asymmetrical movement of _____

Back 44

Facial Muscles

Front 45

Cause?

Back 45

Activation of Herpes Simplex 1 Virus. Reactivation causes inflammation, edema, ischemia, and even demyelination of the nerve, creating pain and alterations in motor/sensory function, more motor related

Front 46

A _____ disruption of MOTOR BRANCHES of cranial nerve 7, causing?

Back 46

UNILATERAL; Facial paralysis (inability to move)

Front 47

While some patients recover, a majority continue to be bothered by weakness and ____ movement of facial muscles

Back 47

Asymmetric

Front 48

Symptoms affiliated with Bell's Palsy

Back 48

Pain in or around posterior ear, usually prior to paralysis= (the loss of the ability to move (and sometimes to feel anything), fever, tinnitus (buzzing) or outbreak of herpes vesicles in or around ear. Other symptoms include decreased hearing, drooping of mouth with drooling, inability to close eyelid with attempt to close lid, decreased or increased tearing, turning out of lower lid, nasolabial fold flattening, inability to frown, smile+ altered chewing obviously (from the decreased muscle movement)

Front 49

Unilateral loss of ____ is often common

Back 49

Taste

Front 50

What causes the abnormal tear production?

Back 50

Muscle weakness, causes the muscle to turn out and leak fluid

Front 51

Diagnostics of Bell's Palsy done by?

Back 51

One of exclusion-no definite test. Done by history of presentation and an EMG (signs/testing of percutaneous nerve excitability)

Front 52

What is the treatment goal?

Back 52

RELIEF OF SYMPTOMS, Prevent complications, protect the affected eye, moist heat, gentle massage, electrical stimulation of nerve and exercises to increase muscle tone and prevent atrophy

Stimulation may help to maintain muscle tone and prevent weakness.

Front 53

What is the key for effective treatment? Hint EARLY ____ and ____

Back 53

Assessment and Diagnosis

Front 54

Medications that are affiliated with Bell's Palsy (Think: Inflammation) General classification+Specific

Back 54

Corticosteroids (Ex: Prednisone)- To treat swelling around that nerve.Best results if initiated before paralysis is complete.

Front 55

When the patient improves to the point where corticosteroids are no longer necessary, they should be tapered off over a ___ week period

Back 55

2

Front 56

The corticosteroids should decrease the? 2 Main, but what else can be used if necessary?

Back 56

Edema and pain, although mild analgesics can be used if necessary

Front 57

If HSV, use ______with corticosteroid

Back 57

Antiviral med (Ex: Acyclovir (Zovirax) and Valacyclovir (Valtrex.)

Front 58

What is extremely critical regarding Bell's Palsy?

Back 58

Early recognition

Front 59

If anyone is prone to herpes simplex, tell them to seek help immediately if pain occurs in or around the?

Back 59

Ear

Front 60

As nurses we need to assess facial muscles for any signs of?

Back 60

Weakness

Front 61

The patient with Bell's Palsy is treated on an ______ basis

Back 61

outpatient

Front 62

What can help decrease the pain of herpetic lesions?

Back 62

Hot and cold packs (surprisingly), MONITOR pain

Front 63

Other interventions:

Back 63

monitor nutrition- chew on unaffected side, oral hygiene; dark glasses for protection and cosmetic reasons, artificial tears to add moisture, facial sling and massage with upward motions; exercise when function returns, REASSURANCE THAT NOT DUE TO STROKE, and good chance of fully recovery

Front 64

It's very important to reassure patients that their Bell's Palsy is not due to a?

Back 64

Stroke

Front 65

Tell the patient to protect the face from cold and drafts, as ________ may accompany the syndrome, which:

Back 65

Trigeminal Hyperesthesia (extreme sensitivity to pain/touch)

Front 66

Artificial tears are used to prevent drying of the_____ (Ex:)

Back 66

Cornea, Methylcellulose (Should be instilled frequently throughout the day)

Front 67

What can be used at night to retain moisture in the eyes?

Back 67

Impermeable eye shield and ointment

Instruct pt. to report ocular pain, drainage, or discharge

Front 68

Facial slings can help provide?

Back 68

Support for affected muscles, improve lip alignment, and facilitate eating

Front 69

6 ____= majority of cases treated

Back 69

6 months (most of the time it will resolve on its own)

Front 70

Herpes Zoster AKA

Back 70

Shingles

Front 71

Define Shingles

Back 71

A reactivation of the chickenpox virus in the body, causing a painful rash.

Front 72

What virus is being activated and possibly why?

Back 72

Varicella Zoster (Chicken Pox), possible due to change in immune system stress, or immunosuppressed patients

Front 73

Are patients contagious?

Back 73

Only to those who have NOT had chicken pox/varicella, or who haven't had the vaccine, OR those who are immunocompromised. Pregnant woman need to stay away!!!

Front 74

Which vaccine helps prevent the occurrence of herpes zoster?

Back 74

Zostavax (for those greater than or = to 60, with a history of varicella

Front 75

Symptoms of Herpes Zoster

Back 75

Linear patches of vesicles along dermatome (nerve path), unilateral on truck region; burning pain precedes outbreak(rash); mild to SEVERE pain during OUTBREAK

Progresses

Can actually bbilateral if cranial nerves affected

Front 76

Treatment for Herpes Zoster

Back 76

Antivirals, wet compresses, and petroleum to lesions. Other than that, nothing really topical.; analgesics

Front 77

Postherpetic neuralgia will often accompany shingles

Back 77

Postherpetic neuralgia is a nerve pain due to damage caused by the varicella zoster virus. Can last up to a year (nervepain) Medication: Antisezure medications for the inflammation and pain

Front 78

Medications specifically for this:

Back 78

Neurontin (for nerve pain/decreased firing, along with those anti-seizure), lidocaine patches :

Front 79

Bells Palsy (7) and difference between stroke symptoms?

Back 79

Bells involves primarily the face/unilateral, whereas stroke involves the extremeties . Also we don't see matoosies (drooping of upper eyelid) with stroke patients. Pt can raise arms, etc.

Front 80

What types of tests will we run to make sure the patient didn't have a stroke?

Back 80

CT, MRI

Front 81

If you have had chicken pox, you can get

Back 81

Varicella Zoster

Front 82

If you have had shingles, can you get them again?

Back 82

Yes; different area maybe

Front 83

Varicella Zoster causes both?

Back 83

Chicken Pox AND Shingles